HX64093956 
R154.Ag6  W58        Memoir  of  D.  Hayes  A 


RECAP 


MEMOIR 


OF 


D.  HAYES  AGNEW,  M.D.,  LL.D, 


Prepared  at  the  request  of  and  read  before  the  College  of  Physicians, 
Philadelphia,  January  4,  1893, 

By  J.  WILLIAM  WHITE,  M.D., 

PROFESSOR   OF  CLINICAL  SURGERY   IN   THE  UNIVERSITY   OF   PENNSYLVANIA, 


(Reprinted from  University  Medical  Magazine,  February,  /8g3.) 


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in  2010  with  funding  from 

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D.,  HA  YES  AGXEIV,   AI.D.,   LL.D. 


MEMOIR 


OF 


D.  HAYES  AGNEW,  M.D.,  LLD. 


Prepared  at  the  request  of  and  read  before  the  College  of  Physicians, 
Philadelphia,  January  4,  1893, 

Bv  J.   WILLIAM  WHITE,   M.D., 

PROFESSOR    OF    CLINICAL    SURGERY    IX    THE    UNIVERSITY    OF    PENNSYLVANIA. 


(^Reprinted  from  Unh'eisity  Medical  MagaziTte,  February,  l8g3.) 


MSI 


MEMOIR  OF  D.  HAYES  AGNEW,  M.D.,  LL.D. 


In  discharging  the  task  which  has  been  assigned  to  me  by  the 
President  of  the  college,  and  which  I  regard  as  at  once  a  duty  and  an 
honor,  I  do  not  propose  to  detain  you  with  an  account  of  the  early  life 
and  work  of  Dr.  Agnew,  nor  with  many  biographical  dates  or  details. 
The  excellent  custom  of  embodying  such  information  in  the  memoirs  of 
distinguished  Fellows  may  well  be  disregarded  in  this  instance,  as  a 
biography  of  Dr.  Agnew  just  published  gives  the  main  incidents  of  his 
long  and  useful  career.  I  shall,  accordingly,  content  myself  with  the 
briefest  possible  statement  of  the  facts  which  seem  essential  in  attempt- 
ing to  arrive  at  a  just  estimate  of  his  position  and  rank  in  the  profession 
of  this  country  and  among  the  surgeons  of  the  world,  and  with  a  few 
reminiscences,  in  which  I  beg  you  to  excuse  occasional  mention  of  my 
own  views  or  experiences,  for  the  reason  that  everything  relating  to 
him  is  of  interest  to  hundreds,  and  is,  therefore,  worth  recording. 

He,  himself,  said  not  very  long  ago,  in  a  sketch  of  his  dear  friend, 
Dr.  Beadle,  that  "to  preserve,  in  some  tangible  or  permanent  form,  a 
record  of  the  life-work  of  those  who,  after  having  achieved  distinction 
in  some  one  or  more  of  the  various  spheres  of  human  pursuits,  have 
gone  to  swell  the  ranks  of  the  great  silent  majorit}'-  is  a  custom  no  less 
commendable  than  beautiful." 

Dr.  Agnew  was  born  in  Lancaster  County,  November  24,  18 18,  of 
a  family  which,  it  is  said,  can  be  traced  through  many  generations  of 
North  of  Ireland  and  Scotch  ancestry  to  Norman  progenitors.  In  this 
country,  for  nearly  two  centuries,  it  has  been  prominent  in  the  history 
of  Pennsylvania,  and  especially  in  that  of  the  county  of  his  birth.  He 
was  educated  at  Moscow  College,  in  Chester  County,  spent  some 
time  (1833-34),  3.t  Jefferson  College,  in  Canonsburg,  Pa.,  and  a 
year  (1834-35),  at  Delaware  College,  Newark,  Del.  He  graduated  in 
the  medical  department  of  the  University  of  Pennsylvania  in  1838, 
before  he  was  twenty- one  years  of  age.  The  first  few  years  of  his  pro- 
fessional life  were  spent  in  practice  in  the  vicinity  of  Nobleville  and 
Pleasant  Garden,  Chester  County.  During  this  time  he  married  (1841), 
and,  being  invited  to  enter  the  business  which  had  been  left  b)^  his 
wife's  father,  he  joined  his  brothers-in-law  in  the  formation  (1843)  of 


4  Memoir  of  D.  Hayes  Agnexv,  M.D.,  LL.D. 

the  firm  of  Irwin  &  Agnew,  iron  founders.  Fortunately  this  venture 
was  unsuccessful.  The  firm  failed  in  three  years  (1846),  from  causes- 
associated  with  a  general  depression  of  the  iron  industry,  which 
occurred  at  that  time,  and  from  the  absence  in  the  locality  of  their 
works  of  sufficient  facilities  for  the  transportation  of  ore  and  fuel.  Dr. 
Agnew  returned  to  the  practice  of  medicine,  and  for  two  years  (1846-48), 
practiced  in  Chester  and  Lancaster  Counties.  He  was  not  content, 
however,  with  the  future  which  opened  up  before  him.  His  natural 
bent  was  toward  the  study  and  teaching  of  anatomy  and  surgery.  In 
the  country  opportunities  for  dissection  were  obtained  with  the 
greatest  difficulty,  and  there  were  not  only  no  classes  to  whom  to 
impart  information,  but  no  colleagues  or  co-workers  with  whom  to 
discuss  it.  For  these  reasons,  and  probably  because  he  had  a  conscious- 
ness, even  though  vague  and  unformulated,  of  the  capacity  for  good 
work  which  lay  within  him,  he  came  to  Philadelphia,  in  1848,  with  the 
purpose  of  making  it  his  permanent  home,  and  of  prosecuting  his 
studies  in  his  favorite  subjects. 

I  have  always  regarded  this  step  of  Dr.  Agnew's  with  unmixed 
admiration.  He  was  then  thirty  years  of  age.  He  had  had  seven 
years  of  country  practice  and  three  years  of  business  experience.  His 
life  thus  far  had  been  a  hard  and  laborious  one;  his  disappointments 
must  have  been  bitter  and,  as  regards  his  extra- professional  essay, 
almost  overwhelming.  He  had  not  only  failed  to  accumulate  any 
capital,  but  he  had  business  debts  which,  to  his  sensitive  and  upright- 
nature,  seemed  obligations  which  he  was  bound  in  honor  to  repay. 

He  left  the  region  in  which  he  had  been  born  and  reared,  the 
friends  of  his  family  and  of  his  early  manhood,  the  patients  who  had 
learned  to  trust  and  depend  upon  him,  and  came  to  a  city  in  which  the 
profession  was  overcrowded,  the  competition  for  place  and  practice 
keen  and  unceasing,  and  the  aspirants  for  both  the  honors  and  the 
rewards  of  medicine  many  and  able.  The  move  is,  perhaps,  the  earliest 
traceable  indication  in  his  public  life  of  the  self-reliance  and  clear- 
sightedness which  came  to  be  recognized  as  among  his  most  marked 
characteristics. 

After  some  deliberation'  he  established  himself  in  a  large  old- 
fashioned  house  at  16  N.  Eleventh  Street,  where  I  first  saw  him  when, 
as  a  boy  of  ten,  I  took  a  note  to  him  from  my  father,  asking  him  to  see 
a  surgical  case  in  a  member  of  our  family.  This  was  in  i860.  For 
twelve  years  he  had  been  laying  the  foundations  of  his  future  success. 
In  1852  he  had  begun  his  teaching  of  practical  anatomy  and  operative 
surgery  at  the  Philadelphia  School  of  Anatomy,  and  his  name  is  still 
the  most  distinguished  in  the  long  list  of  able  men  who  have  been  con- 
nected with  that  institution.     In   1854  he  had  been  elected  a  surgeon. 


Memoir  of  D.  Hayes  Agnew^  M.D.,  LL.D.  5 

to  the  Philadelphia  Hospital,  and  had  thus  been  given  not  only  his  first 
hospital  wards,  but  also  his  first  opportunity  to  perfect  himself  in  the 
teaching  of  clinical  surgery.  He  always  regarded  this  step  as  one  of 
the  most  important  in  his  professional  life,  and  once  in  speaking  of  it 
to  me,  said  he  had  already,  at  that  time,  decided  that  he  "might  as 
well  attempt  to  be  a  gardener  without  a  garden  as  a  surgeon  without  a 
hospital."  He  had  also,  for  two  years,  been  occasionally  substituting 
lor  Dr.  Henry  H.  Smith,  professor  of  surgery  at  the  University,  in 
giving  clinical  instruction  to  the  students.  At  the  time  of  which  I 
speak  (i860)  his  reputation  as  an  able  operator  and  a  sound  con- 
sultant was  firmly  established  and  rapidly  spreading,  but  his  practice 
was  not  yet,  as  he  has  told  me,  what  would  now  be  called  a  lucrative 
one.  He  was,  however,  only  forty-two  years  of  age,  in  the  enjoyment 
of  the  fullest  mental  and  physical  vigor,  and  undoubtedly  saw  success 
within  his  grasp.  I  remember  well  the  kindly  manner  in  which  he 
received  me,  and  the  promptness  with  which  he  left  the  fire,  befv^re 
which  he  had  been  reading,  changed  his  slippers  for  shoes,  and  pre- 
pared to  answer  the  call  which  I  had  brought,  although  it  was  late  on 
a  disagreeable  evening.  He  had  then,  as  always,  an  impressive  per- 
sonality and  a  magnetism  felt  by  most  persons  who  came  within  the 
sphere  of  his  influence.  It  was  not  of  the  sort  that  is  exploited  in  the 
journals  as  characterizing  brilliant  politicians  and  successful  criminal 
lawyers,  nor  yet  of  the  variety,  which  historj^  teaches  us,  has  been 
possessed  by  many  great  statesmen  and  victorious  generals.  If  I 
attempted  to  epitomize  or  explain  the  secret  of  Dr.  Agnew's  attrac- 
tiveness to  so  many  and  such  different  classes  of  people,  I  would  say 
that  "kindliness"  expressed  it  perhaps  better  than  any  other  word. 
There  were  strength  and  energy  and  determination  back  of  it,  with  a 
basis  of  broad  knowledge  and  justifiable  self-confidence;  but,  all  the 
same,  the  chief  impression  he  made  was  of  a  tender  benevolence  which 
always  regarded  the  feelings  and  interests  of  others,  and  which  pervaded 
his  whole  atmosphere.  It  was  noticeable  then  even  to  a  child,  and  it 
grew  as  he  advanced  in  years,  until  the  title  of  the  "  Dear  Old  Man," 
which  was  given  him  by  the  younger  Gross,  was  universally  accepted 
as  in  the  highest  degree  applicable. 

During  the  civil  war  Dr.  Agnew  had  large  opportunities — chiefly 
at  the  Hestonville  General  Hospital — for  operative  work,  and  it  is  need- 
less to  say  profited  by  them  to  the  utmost.  In  1863  he  was  elected 
surgeon  to  Wills'  Eye  Hospital;  in  1865,  surgeon  to  the  Pennsylvania 
Hospital ;  in  1867,  surgeon  to  the  Orthopedic  Hospital;  in  1870,  pro- 
fessor of  Clinical  Surgery,  and  in  187 1,  professor  of  Surgery  in  the 
University  of  Pennsylvania,  retaining  the  latter  positions  until  1889, 
when  he  resigned  them  to  be  created  emeritus  professor  of  Surgery,  and 
honorary  professor  of  Clinical  Surgery. 


6  Memoir  of  D.  Hayes  Agnezv,  M.D.,  LL.D. 

During  all  these  years  he  grew  steadily  in  professional  strength, 
his  clinics  were  crowded,  his  office  was  filled,  his  services  were  in  daily 
demand  in  all  parts  of  the  Middle  States,  and  the  University  of  Penn- 
sylvania was  sending  out,  year  after  year,  hundreds  of  young  men  who 
regarded  him,  and  justly,  as  the  best  possible  adviser  in  all  cases  of 
surgical  disease  or  injury. 

His  election  in  1889  to  the  Presidency  of  the  College  of  Physicians 
was  a  distinction  which,  like  all  the  others,  came  to  him  unsought  and 
unsolicited  but  which  he  nevertheless  highly  appreciated.  It  resulted 
from  the  very  wide-spread  feeling  in  the  college  that  he  should  not  be 
permitted  to  end  his  days  without  adding  his  name  to  the  list  of  those 
gentlemen  who,  without  exception,  have  for  years  reciprocally  honored 
and  been  honored  by  this  organization,  perhaps  the  most  conservative 
in  America. 

My  personal  remembrances  of  him  begin  again  in  the  winter  of 
1868  when,  twice  a  week,  after  supper,  I  used  to  hurry  back  to  the 
University  to  get  a  front  seat  at  his  half-past  seven  o'clock  lectures  on 
surgical  anatomy.  He  was  then  probably  the  most  popular  teacher  at 
the  University,  and  deservedly  so.  I  certainly  have  never  heard 
lectures  on  anatomy  which,  for  clearness  of  description,  actual  teaching 
force  and  living  interest,  could  compare  with  those  which  he  then  gave. 
On  those  two  nights  the  room  was  crowded  with  the  students  of  both 
classes  and,  as  he  always  spent  the  latter  part  of  the  evening  in  the 
dissecting-room,  every  subject  was  surrounded  by  its  full  quota  of  dili- 
gent workers  who,  if  I  may  judge  others  by  myself,  found  the  chief 
attraction  in  the  chance  of  getting  a  pleasant  word  of  advice  or  instruc- 
tion from  him. 

He  looked  then  very  much  as  he  did  for  the  next  twenty  years  of 
his  life.  His  hair  was  already  thinning  and  beginning  to  turn  white, 
as  was  the  moustache,  which  was  prolonged  on  the  cheeks  in  a  military 
fashion.  His  height,  of  more  than  six  feet,  and  his  fine  muscular 
development  made  his  figure  commanding  in  spite  of  the  slight  profes- 
sional stoop  which  he  always  had,  the  result  of  hours  spent  over  sick- 
beds and  operating  tables.  His  blue  eyes  were  keen  but  kind  in  their 
expression.  An  old  blue  dress-coat  with  brass  buttons,  which  he 
wore  to  these  lectures,  gave  him,  I  remember,  to  my  imagination,  a  mili- 
tary air,  and  this  fancy  came  back  to  me  in  one  of  his  last  attacks  of 
illness,  when  I  found  him  sitting  up  in  bed  with  a  handkerchief  tied 
around  his  forehead  on  account  of  a  severe  supra- orbital  neuralgia.  He 
looked  like  a  wounded  grenadier.  I  told  him  of  my  boyish  idea  about 
the  blue  coat,  which  he  recalled,  and  said  smilingly  he  would  hardly 
venture  to  wear  it  before  a  medical  class  of  the  present  day,  in  spite  of 
their  alleged  improvement  in  manners.     He  has  twice  in  my  presence 


Memoir  of  D,  Hayes  Agyiew,  M.D.,  LL.D.  7 

alluded  to  himself,  half  laughingly,  half  seriously,  as  "homely." 
Homely  he  was  in  the  sense  in  which  Chaucer  and  most  English  people 
at  the  present  day  employ  the  word,  that  is,  he  was  domestic  in  habits 
and  simple  and  affable  in  manners ;  but  homely  in  our  perverted 
American  signification,  which  usually  implies  not  only  plainness  of 
feature  but  positive  ugliness,  he  never  was.  A  cold-blooded  critical 
analysis  of  his  features  might  disclose  some  reason  for  such  an  opinion, 
but  no  one  who  knew  him  looked  at  Dr.  Agnew  in  that  spirit.  Good- 
ness and  kindness  of  character  shine  so  clearly  through  some  faces  that 
defects  or  irregularities  are  forgotten,  and  his  was  one  of  them. 

The  College  of  Physicians  and  the  University  are  fortunate  in  pos- 
sessing masterly  portraits  of  him,  which  will  help  to  bring  before  future 
generations  of  Fellows  and  of  students  his  striking  personality.  We 
of  the  present  day  need  no  such  reminders.  We  carry  his  likeness  in 
our  hearts. 

In  reviewing  his  life  one  is  struck  with  the  fact  that  both  hereditary 
and  personal  influences  were  such  as  favored  the  growth  and  develop- 
ment of  that  side  of  his  character  upon  which,  as  fate  willed  it,  the 
greatest  demand  was  to  be  made  in  years  to  come.  The  strain  of 
Scotch  blood  brought  with  it  dogged  perseverance,  enduring  patience, 
disregard  of  luxury,  even  of  personal  comfort,  ability  to  sustain  uncom- 
plainingly the  reverses  of  fortune,  and  to  submit  contentedly  to  the 
long- continued  economies  which  they  necessitated.  But  it  must  be 
added  that  these  virtues,  so  often  associated  with  a  sombre  or  stern  dis- 
position, were  in  his  case  tempered  by  geniality,  cheerfulness  and  an 
unvarying  and  all-embracing  tolerance  that  was  one  of  his  chief  char- 
acteristics. 

The  wholesome  out- door  life  which  he  led  in  the  country  for  so 
long  a  time  was  the  best  sort  of  ' '  physical  culture, ' '  and  doubtless  those 
years,  which  he  sometimes  thought  had  been  in  a  sense  wasted,  came 
back  to  him  in  the  form  of  increased  energy,  endurance  and  good 
health  later  in  life.  His  very  misfortunes  supplied  an  additional 
stimulus  to  a  character  which  naturally  was  so  domestic  and  affection- 
ate that  ambition  alone  might  not  have  brought  about  its  transplanta- 
tion from  the  familiar  soil  in  which  it  had  been  reared  and  nourished. 

It  is  a  trite  observation  that  our  apparent  trials  often  prove  to  be 
our  greatest  blessings.  There  can  be  little  doubt  that  Dr.  Agnew  con- 
tained within  him  the  qualities  which  would  have  commanded  success, 
even  under  the  unfavorable  conditions  associated  with  material  pros- 
perity, but  neither  is  it  doubtful  that  the  years  spent  while  waiting  for 
practice,  when  he  went  to  the  dissecting-room  after  his  morning  office 
hours,  went  back  after  his  midday  dinner,  spent  most  of  the  afternoon 
there  and  returned  after  an  early  supper  to  leave  only  when  the  last 


8  Memoir  of  D.  Hayes  Agneii\  M.D.,  LL.D. 

student  had  gone  and  the  lights  were  extinguished,  were  the  years 
during  which  he  laid  broad  and  deep  the  foundations  of  his  success. 
They  were  years,  also,  the  reward  of  which  was  not  postponed  to  a 
future  period.  Dr.  Agnew  has  often  told  me  that  on  the  whole  he 
regarded  the  days  spent  in  the  rooms  on  Chant  Street,  the  "Windmill 
Street ' '  of  Philadelphia,  as  the  happiest  days  of  his  life,  and  he  once  at 
least  made  the  same  statement  in  public. 

When  we  come  to  estimate  the  true  value,  and  the  real  and  en- 
during position  of  one  of  our  profession  who  has  left  us,  we  can, 
perhaps,  adopt  no  better  gauge  than  the  opinion  of  his  pupils.  History 
shows  us  that  almost  invariably  the  surgical  contemporaries  of  a  great 
surgeon,  with  whatever  affection  they  may  have  cherished  him,  were 
still,  in  a  sense,  his  rivals ;  they  learned,  or  failed  to  learn,  at  the  same 
time,  or  by  the  same  stern  experiences ;  they  often  differed  and,  being 
human,  when  they  chanced  to  be  right  derived  an  increased  pleasure 
from  the  fact  that  he  was  wrong;  their  estimate,  in  other  words,  was 
often  unconsciously  tinctured  by  personal  prejudice,  or  influenced  by 
motives  not  apparent  to  themselves.  Who  would  to-day  be  content  to 
accept  Cline's  opinion  of  Sir  Astley  Cooper,  or  Ferguson's  of  Syme,  or 
Syme's  of  Liston,  or  Pott's  of  John  Hunter? 

Dr.  Agnew,  more  than  any  man  of  equal  eminence  in  our  pro- 
fession with  whose  history  I  am  familiar,  was  free  from  this  sort  of 
belittling  animosity  toward  others  and,  perhaps  as  a  consequetice, 
rarely  if  ever  excited  it.  But  when  one  dies  at  seventy- four,  after  more 
than  a  half-century  of  professional  work,  few  of  his  own  years  are  left 
to  testify,  and  still  fewer  are  apt  to  place  on  record  their  final  and 
deliberate  judgment. 

The  laity,  however  sincere  their  admiration  and  however  well- 
founded  it  may  sometimes  prove,  are  essentially  unfit  to  pronounce 
upon  the  claims  of  medical  men  to  either  present  or  posthumous 
honors.  They  are  too  apt  to  mistake  show  for  brilliancy,  self-assertion 
for  force  of  character  and  notoriety  for  fame.  In  Dr.  Agnew' s  case 
they  held  him  at  his  just  value,  but  their  verdict  can  never  be  regarded 
as  final  or  conclusive. 

It  is,  after  all,  in  the  case  of  great  surgeons  at  any  rate,  upon  the 
testimony  of  their  pupils  that  their  ultimate  place  in  the  history  of  our 
profession  depends.  Nearly  every  surgeon  who  has  made  his  name 
immortal  has  been  a  teacher,  and  usually  as  great  a  teacher  as  he  was 
a  surgeon.  For  one  exception  like  John  Hunter,  a  hundred  illustrious 
names  could  be  adduced  to  emphasize  the  truth  of  this  statement. 
Their  lives  have  been  written,  their  merits  described,  their  achieve- 
ments recorded,  their  virtues  extolled  by  those  whom  they  have  taught 
and  guided,  and  Dr.  Agnew  constitutes  no  exception. 


Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D.  9 

From  the  length  and  breadth  of  this  land  the  pupils  whom  for  ten 
years  (i 852-1 862)  he  instructed  in  the  Philadelphia  School  of  Anatomy, 
and  those  who  during  the  next  thirty  years  had  the  paths  of  surgical 
science  made  easy  for  them  in  the  University  of  Pennsylvania  by  his 
wise,  clear,  practical  teachings  have  over  and  over  again  testified  to 
their  respect  for  him  living  and  their  reverence  for  him  dead.  Their 
estimate,  their  decision,  will  be  those  accepted  by  future  generations, 
and  upon  them  Dr.  Agnew's  fame  will  rest  justly  and  securely. 

This  professional  reputation,  thus  testified  to,  will  be  found  to 
depend  chiefly  upon  the  following  factors:  (i)  The  clearness  of  his 
teachings ;  (2)  the  soundness  of  his  judgment ;  (3)  the  precision  of  his 
operations;  (4)  the  character  of  his  writings. 

Of  course,  some  of  his  success  was  due  to  the  personal  qualities 
which  have  already  been  mentioned.  A  man  who  cannot  enter  a 
household  or  a  sick-room  without  diffusing  about  him  the  almost 
indescribable  sense  of  repose  and  confidence  that  he  inspired,  the 
feeling  on  the  part  of  the  anxious  or  grief-stricken  relatives  that 
however  the  case  is  going  everything  humanly  possible  is  being  done 
for  the  patient,  and  on  that  of  the  medical  attendant  that  exhaustive 
consideration  has  been  given  to  every  detail  of  the  treatment,  such  a 
man,  I  say,  is  certain  of  increasing  practice  as  soon  as  he  has  made  a 
beginning,  and  has  become  known  to  the  public  and  the  profession. 
Something  of  this  quality  is  occasionally  inherent  in  men  whose 
natural  knowledge  and  capacity  do  not  justify  it.  The  public  is  then 
deceived  for  a  time,  but  the  profession  rarely  or  never.  To  the  degree 
in  which  it  was  possessed  by  Dr.  Agnew,  it  may  safely  be  said  it  is 
never  found  except  in  association  with  wide  experience,  broad  profes- 
sional culture  in  the  best  sense  of  the  word,  and  pre-eminent  ability. 
In  its  effect  upon  the  acquiring  of  practice  it  is  perhaps  more  important 
than  any  of  the  factors  above  mentioned,  but  the  reputation  which  it 
brings  is  evanescent,  and  when  years  have  elapsed  it  will  be  found,  as 
I  have  said,  that  the  surgeon  will  be  known  to  posterity,  if  known  at 
all,  as  a  teacher  or  writer,  a  consultant  or  operator,  not  simply  as  a 
successful  practitioner. 

fi)  As  a  teacher  he  was  remarkable  for  his  simple,  plain,  straight- 
forward methods,  his  entire  disregard  of  oratorical  effort,  his  faculty  of 
making  clear  and  easily  comprehensible  even  the  abstruse  and  com- 
plicated portions  of  his  subject.  He  never  spent  time  or  labor  upon 
mere  eloquence,  but  was  alwaj^s  so  earnest  and  so  obviously  desirous 
of  conveying  information  as  to  hold  the  attention  of  his  class,  and  so 
concise  and  practical  as  to  leave  his  teachings  indelibly  impressed  upon 
their  memories.  His  views  were  so  evidently  the  outcome  of  mature 
experience,  and  so  stamped  with  the  seal  of  honest  conviction,  that  his 


lo  Memoir  of  D.  Hayes  Agneiv,  M.D.,  LL.D. 

enunciation  of  them  gained  added  impressiveness  and  made  his  course 
upon  surgery  not  only  one  of  the  most  useful,  but  also  one  of  the  most 
pleasant,  of  their  University  experiences,  to  thousands  of  under- 
graduates. Without  apparent  effort,  and  with  a  skill  born  of  thorough 
knowledge  and  perfect  mastery  of  his  theme,  each  subject  was  presented 
to  the  student  so  clearly,  simply  and  directly,  that  it  remained  a  part 
of  his  medical  knowledge.  His  lectures  were  very  uniform  in  quality, 
but  I  recall  with  especial  admiration  those  upon  hernia,  upon  fractures, 
and  upon  the  ligation  of  arteries.  To  my  mind  they  were  models  of 
what  surgical  teaching  should  be.  I  have  heard  the  same  opinion 
expressed  many  times  by  alumni  who  preceded  and  by  those  who 
followed  me  at  the  University,  and  neither  my  reading  nor  my  experi- 
ence leads  me  to  believe  that  those  lectures  would  suffer  by  comparison 
with  the  teachings  of  the  greatest  masters  of  our  art  in  this  or  any 
previous  epoch. 

His  habit  at  his  clinic  was  to  precede  his  operation  by  a  brief  state- 
ment of  the  history  of  the  case,  and  by  some  remarks  upon  diagnosis  and 
prognosis,  and  upon  his  reasons  for  choosing  the  particular  operative 
method  he  was  about  to  employ.  During  the  operation  itself  he  said 
but  little.  Afterward  he  would  usually  leave  some  of  the  final  details, 
the  arrest  of  hemorrhage,  insertion  of  sutures,  application  of  dressings, 
etc.,  to  his  assistant,  while  he  explained  more  fully  what  he  had  just 
done,  and  described  what  he  had  observed.^ 

He  possessed  to  a  remarkable  degree  the  power  of  interweaving 
with  his  admirable  descriptions  of  surgical  diseases  and  injuries  the 
underlying  anatomical  facts  upon  which  accurate  diagnosis  and 
successful  treatment  so  commonly  depend.  Indeed,  as  a  practical 
surgical  anatomist  he  was  in  this  country  without  a  peer,  and  much  of 
his  success  arose  from  his  well-earned  reputation  in  this  department. 

He  was  a  natural  teacher,  always  ready  and  pleased  to  impart 
information  even  outside  of  his  lectures  to  any  one  seeking  it  in  the 
proper  spirit,  and  did  so  in  the  clearest  and  most  agreeable  manner 
possible,  making  the  dullest  subject  seem  interesting,  and  investing  it 
with  a  more  extended  significance  by  some  illustrative  or  cognate  fact. 

He  never,  however,  forgot  the  interests  of  his  patients  in  his  desire 
to  convey  instruction.  I  held  the  staff  for  him  for  some  time  and  in  a 
great  many  lithotomies  before  I  had  much  experience  in  cutting  for 
stone  myself.  He  knew  this,  but  as  he  did  not  believe  in  a  multiplicity 
of  fingers  in  wounds,  or  in  removing  the  finger  in  these  cases  until  the 

'  The  cut  on  the  opposite  page  is  from  a  photograph  taken  by  a  member  of  the  class.  The 
case  was  one  of  malignant  growth  of  the  foot,  r  ecessitating  amputation  of  the  leg.  The  period 
was  that  during  which  we  employed  the  carbolic  spray  at  all  operations,  but  before  the  use  of 
operating  gowns  had  come  into  vogue  here.  Dr.  Agnew  had  finished  his  preliminary  remarks 
and  was  about  to  begin  the  operation. 


Memoir  of  D.  Hayes  Agjtezv,  M.D.,  LL.D.  ii 

forceps  were  in  the  bladder,  he  never  but  once  asked  me  to  explore 
that  organ  prior  to  the  removal  of  the  calculus.  On  that  occasion  we 
were  operating  in  a  little  town  in  the  southern  part  of  Delaware. 
After  making  the  usual  incision  and  putting  his  finger  in  the  bladder, 
he  spent  a  long  time  in  exploring  the  bas  fond  and  the  post- prostatic 
pouch  in  search  of  the  stone  which  we  had  both  heard  and  touched 
with  the  staff.  Presently  he  asked  me  to  slip  my  finger  in  as  he  with- 
drew his,  as  the  condition  was  so  extraordinary  that  he  would  like  me 
to  feel  it.  The  stone  was  swinging  like  a  pendulum  from  the  summit 
of  the  bladder,  held  there  by  a  band  of  organized  lymph  quite  firm  and 
resistant. 

The  case  was  unique  in  his  experience. 

(2)  As  a  consultant  and  as  a  practitioner  perhaps  his  most  note- 
worthy quality  was  the  soundness  of  his  judgment.  Partly  from  his 
natural  clearness  of  mental  vision  and  good  common  sense,  partly  from 
his  thorough  preparatory  training  and  his  diligent  and  incessant  study 
of  everything  that  bore  upon  the  teaching  and  practice  of  all  depart- 
ments of  surgery,  and  partly,  no  doubt,  from  the  enormous  experience 
which  in  later  years  he  could  utilize  for  his  guidance,  he  made  singu- 
larly few  mistakes  in  either  the  diagnosis  or  the  treatment  of  surgical 
conditions. 

It  is  given  to  none  of  us  to  be  infallible  ;  error  and  humanity  are 
now,  as  always,  inseparable ;  perfect  wisdom  and  complete  knowledge 
in  even  the  narrowest  of  human  occupations  are  unattainable.  I  desire 
to  make  no  exaggerated  claim  for  the  subject  of  this  memoir,  but  I  feel 
sure  that  at  least  to  this  audience,  which  numbers  so  many  who  looked 
■upon  him  as  the  court  of  last  appeal  in  all  surgical  matters,  I  may 
venture  to  state  my  belief  that  few  surgeons  have  ever  lived  who,  in 
the  presence  of  an  obscure  case,  were  so  uniformly  correct  in  their 
estimate  of  the  precise  diagnostic  value  of  a  surgical  symptom,  so 
accurate  in  their  application  of  the  general  principles  bearing  upon  the 
condition  in  question,  and  so  conversant  with  all  the  varied  possi- 
bilities which  such  cases  present.  His  ability  to  unravel  the  tangled 
web  of  disease,  to  solve  its  intricate  problems,  seemed  to  me  in  the 
earlier  days  of  my  association  with  him  to  be  little  short  of  inspiration  ; 
later  I  came  to  recognize  it  as  the  legitimate  outcome  of  keen  observa- 
tion, wide  experience  and  logical  reasoning. 

I  have  often  thought  that  of  all  the  great  surgeons  with  whose  lives 
I  was  familiar  I  could  trace  the  closest  resemblance  between  both  the 
personal  and  the  professional  characteristics  of  Sir  Astley  Cooper  and 
those  of  Dr.  Agnew.  I  once  said  this  to  him,  and  he  replied  that  while 
there  was  no  surgeon  whom  he  would  rather  be  thought  to  resemble,  he 
feared  that,  like    many  other  attempted  parallels  from    the  days   of 


12  Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D. 

Plutarch  until  now,  the  facts  would  have  to  be  made  to  conform  to  the 
theory. 

And  yet  I  may  ask  those  of  you  who  knew  him  best  if  the  follow- 
ing description  of  the  great  English  surgeon  by  his  nephew  might  not 
have  been  written  verbatim  et  literatim  of  Dr.  Agnew  : 

"  His  influence  did  not  arise  from  his  published  works,  nor  from 
his  being  a  lecturer,  nor,  indeed,  from  any  public  situation  which  he 
held,  although  each  of  these  circumstances  had  its  share  in  producing 
the  result ;  but  it  seemed  to  originate  more  from  his  innate  love  of  his- 
profession,  his  extreme  zeal  in  all  that  concerned  it,  and  his  honest 
desire,  as  well  as  great  power,  to  communicate  his  knowledge  to 
another,  without  at  the  same  time  exposing  the  ignorance  of  his 
listener  on  the  subject  even  to  himself.  This  must  be  looked  upon  as 
one  great  cause  why  his  public  character  became  so  much  diffused  by 
his  professional  brethren,  for  he  owed  little  of  his  advancement  in  life 
to  patronage.  Another  peculiar  quality  which  proved  always  a  great 
source  of  advantage  to  him  was  his  thorough  confidence  in  respect  to 
his  professional  knowledge,  so  that  after  he  had  once  examined  a  case 
he  cared  but  little  who  was  to  give  a  farther  surgical  opinion  upon  it. 
This  must  inevitably  have  instilled  an  equal  degree  of  confidence  in 
those  consulting  him." 

To  the  younger  men,  and  especially  to  the  younger  operators  in  the 
profession,  he  was  more  than  a  consultant.  How  many  reputations  he 
has  helped  to  make  by  the  encouragement  and  guidance  which  he 
never  refused ;  how  many  more  he  has  saved  from  wreck  by  the 
protection  and  support  which  his  unassailable  position  permitted  him  tO' 
give  to  those  whose  ignorance,  rashness  or  ill-luck  got  them  into 
surgical  difficulties,  no  one  but  himself  ever  knew.  In  suits  for  mal- 
practice he  was  the  bulwark  and  safeguard  of  dozens  of  unfortunate 
medical  defendants.  He  always  saw  clearly  just  what  could  be  truth- 
fully said  in  explanation  or  extenuation  of  a  bad  result ;  and  although 
in  his  evidence  in  such  cases  he  was  never  known  to  depart  from  the 
strictest  veracity,  he  would  probably  have  himself  pleaded  guilty  tO' 
siippressio  veri  in  more  than  one  instance.  What  was  said  of  Sir  William 
Fergusgon  was  true  of  him  : 

' '  Full  of  experience  himself,  and  able  to  wield  his  powers  so 
brilliantly,  he  was  tender  as  to  the  failure  of  others,  and  nothing  gave 
him  more  pleasure  than  to  have  an  opportunity  of  helping  some  one 
out  of  difficulty,  while  the  manner  in  which  he  gave  this  help  was  as 
graceful  as  the  assistance  itself  was  valuable." 

One  source  of  Dr.  Agnew' s  power  as  a  diagnostician  was  his  very 
retentive  memory  for  even  the  details  of  cases  which  he  had  once  seen. 
No  clinical  observation,  even  of  times  long  past,  escaped  him,  and  as- 


Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D.  13 

for  many  years  he  was  the  chief  consultant  of  three  States,  with  a 
population  of  millions,  his  experience,  almost  without  exception, 
furnished  a  parallel  to  the  rarest  and  most  obscure  conditions.  I  have 
more  than  once  begun  to  describe  to  him  some  recent  experience  or 
observation  of  my  own,  which  seemed  to  me  unique,  only  to  have  him 
interrupt  me  kindly  and  smilingly  and  finish  the  description  as 
accurately  as  if  he  had  been  present  and  had  seen  the  case  himself 
Often,  too,  to  my  great  profit,  he  would  volunteer  some  words  of 
explanation  that  instantly  made  clear  all  that  was  previously  doubtful. 

His  own  powers  of  observation  were  so  well  trained  that  in  many 
surgical  conditions  a  glance  sufficed  for  a  diagnosis,  and  although 
usually  cautious  about  expressing  an  opinion  he  would  sometimes 
venture  upon  a  positive  one  the  moment  he  saw  the  case.  This  was 
notably  so  in  patients  with  complete  scrotal  hernias  or  with  large 
hydroceles,  the  distinction  between  which  he  made  by  the  relation  of 
the  tumor  to  the  anterior  plane  of  the  body ;  in  cases  of  shoulder 
injury,  where  the  position  of  the  patient  revealed  the  presence  or 
absence  of  luxation ;  in  deep  abscesses,  where  a  glance  at  the  overlying 
skin  and  a  touch  with  his  opposing  fingers  completed  his  examination ; 
in  fracture  near  joints  and  in  un- united  fracture,  where  he  almost 
seemed  to  have  a  special  sense  for  determining  preternatural  mobility, 
and  in  many  other  classes  of  cases. 

The  story  which  Vidal  de  Cassis  tells  of  Dupuytren,  that  within  a 
few  days  of  his  death  he  was  asked  his  opinion  of  a  lesion  of  the  elbow 
in  a  patient  who  was  brought  to  his  bedside,  and  without  touching  him 
diagnosed  a  luxation,  which  had  been  denied  by  an  eminent  colleague, 
but  was  subsequently  demonstrated  and  reduced,  might  well  have  been 
told  of  Agnew. 

(3)  In  speaking  of  his  operative  work  I  have  purposely  used  the 
word  precision  to  characterize  it,  instead  of  the  usual  eulogistic  term — 
brilliancy.  Dr.  Agnew  himself  disliked  the  latter  word,  and  with  it 
the  kind  of  operating  which  it  often  described,  in  which  everything  is 
sacrificed  for  the  sake  of  what  in  athletics  would  be  called  a  "  record." 
He  has  more  than  once  told  me  interesting  anecdotes  of  the  difficulties 
into  which  this  habit  of  what  he  called  ' '  slap-dash  ' '  work  had  led  some 
of  his  contemporaries.  He  agreed  with  my  friend  Mr.  Treves,  him- 
self an  exceptionally  able  operator,  who  says  that  the  days  of  the 
so  called  "brilliant"  surgeon  are  over,  and  that  it  is  no  longer  a  matter 
of  primary  importance  that  a  stone  should  be  extracted  or  a  vessel  tied 
-or  a  limb  removed  in  a  limited  number  of  seconds. 

Dr.  Agnew  was  naturally  a  quick  operator,  and  his  training  dated 
back  to  the  days  when  pre-anesthetic  traditions  kept  alive  the  theory 
that  rapid  surgery  was  good  surgery,  but  he  was  above  everything  else 


14  Memoir  of  D.  Hayes  Ag7ieiv,  31. D.,  LL.D. 

a  safe  operator,  a  precise  operator.  His  knowledge  of  anatomy  included 
not  only  that  of  the  dissecting  room,  which,  important  as  it  is,  is  but 
the  beginning  for  the  surgeon,  but  that  of  the  operating  table,  which  is 
often  very  different.  He  knew  not  only  what  the  relations  of  parts  and 
structures  ought  to  be,  but  what  they  were  in  any  particular  case.  He 
knew,  in  other  words,  not  only  the  ordinary  topographical  anatomy  of 
books,  of  the  cadaver,  and  of  the  lecture  room,  which  is  knowledge 
common  to  many,  but  also  the  anatomy  of  the  individual  upon  whom 
he  was  operating,  and  of  the  disease  which  necessitated  his  interference. 
He  has  often  said  to  me  that  no  two  cases  of  hernia  were  precisely  alike 
in  their  anatomical  appearances ;  that  each  dissection  of  the  neck  for 
the  removal  of  a  new  growth  had  a  certain  individuality  which  enabled 
him  to  remember  it  for  years ;  and  that  one  might  cut  through  the  loin 
twenty  times  to  approach  the  colon  or  kidney  and  find  no  two  of  the 
cases  precisely  identical  in  thickness  of  muscular  layers,  amount  of 
peri- renal  fat,  etc. 

It  was  in  this  knowledge  of  the  conditions  and  appearances  to  be 
expected  in  a  given  case,  the  knowledge  of  these  infinite  variations,  that 
he  was  far  superior  to  any  operator  with  whom  I  have  had  a  chance  to 
compare  him.  With  the  splendid  foundation  of  practical  anatomy 
which  his  years  of  teaching  and  demonstration  had  given  him,  his  con- 
stant operating  had  developed  in  him  this  faculty  of  quick  and  certain 
recognition  of  the  structures  exposed  to  view  or  to  touch,  which  gave 
his  work  the  character  of  accuracy  and  precision  that  impressed  every 
one  who  saw  it. 

His  use  of  all  instruments  was  light  but  firm,  devoid  of  flourishes 
or  attempts  at  show,  but  strikingly  graceful.  His  hand  was  very  steady 
up  to  the  last  month  of  his  life.  His  ability  to  work  with  either  hand, 
although  he  did  not  himself  consider  it  of  much  practical  value,  was 
certainly  a  great  convenience,  and  was  a  peculiar  and  striking  feature 
in  his  operating.  He  acquired  it  as  a  consequence  of  a  severe  onychia 
of  the  right  index  finger,  which  destroyed  the  matrix  and  which  deprived 
him  for  a  long  time  of  the  use  of  that  hand,  during  which  period  he 
taught  himself  the  use  of  the  other.^ 

The  general  level  of  his  operative  work  was  so  high  that  it  is  dif- 
ficult to  select  any  particular  cases  or  groups  of  cases  for  special  men- 
tion, but  possibly  his  peculiar  abilities  were  made  most  manifest  during 
the  removal  of  a  deep-seated  growth  of  the  neck  or  of  a  mammary 
tumor,  the  ligation  of  a  large  bloodvessel,  the  extraction  of  a  vesical 
calculus,  or  the  excision  of  a  bone  like  the  superior  maxilla,  or  a  joint 
like  the  knee  or  elbow. 

1  His  hands  had  so  much  individuality,  so  much  of  what  artists  call  "  character,"  that  I  have 
added  to  this  memoir  an  illustration  made  from  a  plaster  cast  taken  after  his  death  by  the  sculp- 
tor, Mr.  Murray. 


DR.   AG  NEWS  IIAXD,   FROM  A   PLASTER    CAST. 


Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D.  15 

One  of  his  most  marked  characteristics  was  his  imperturbability 
described  by  his  former  colleague,  Dr.  Osier,  with  eloquent  reference 
to  its  applicability  to  Agnew  as :  "  Coolness  and  presence  of  mind  under 
all  circumstances,  calmness  amid  the  storm,  clearness  of  judgment  in 
moments  of  grave  peril;  a  quality  which  in  its  full  development  has 
the  nature  of  a  divine  gift,  a  blessing  to  the  possessor,  a  comfort  to  all 
who  come  in  contact  with  him."  This  quality  Dr.  Agnew  had  to  such 
a  degree  that  nothing  that  could  happen  during  a  operation,  however 
unexpected  or  undesirable,  seemed  greatly  to  disturb  him.  Terrific 
and  unlooked-for  hemorrhage,  profound  shock,  alarming  collapse, 
threatened  asphyxia,  all  possible  surgical  accidents  and  emergencies, 
were  embraced  within  his  experience,  and  I  have  seen  him  meet  each 
of  them  in  the  same  prompt,  quiet,  masterful  manner  which  assured  and 
gave  confidence  to  every  one  who  was  working  with  him.  Even  death 
on  the  operating  table  has  come  to  him  without  disturbing  his  equa- 
nimity. He  had  it  occur  once  during  tracheotomy  in  a  desperate  case, 
but  it  was  many. years  ago. 

The  only  other  time  I  know  of,  and  the  only  time  I  ever  saw  Dr. 
Agnew  lose  a  patient  on  the  table,  was  during  an  operation  for  hemor- 
rhoids in  1887  at  the  Bingham  House  in  this  city.  The  patient,  who 
was  apparently  well  and  strong,  had  taken  less  than  four  ounces  of 
ether  and  was  breathing  well  when  the  first  ligature  was  tightened.  His 
respiration  immediately  stopped,  and  although  his  heart  continued  to 
beat  for  nearly  half  an  hour  he  died  without  making  even  an  attempt  at 
respiration.  The  autopsy  showed  an  apoplexy  into  the  floor  of  the  fourth 
ventricle.  That  half  hour  was  one  of  the  longest  in  my  life.  The 
physical  exertions  employed  in  the  efforts  at  resuscitation  were  in  them- 
selves exhausting,  and  in  addition  there  was  the  mental  distress  inci- 
dent to  such  a  sudden  and  unexpected  termination  of  a  minor  case.  At 
the  end  I  was  drenched  with  perspiration,  unnerved  from  excitement 
and  disappointment,  and  felt  ten  years  older.  Dr.  Agnew  was  as  cool 
and  placid  as  if  the  occurrence  was  a  common  one  in  his  experience.  As 
we  walked  down  to  our  carriages  on  Eleventh  Street  he  made  a  remark 
which  I  have  never  forgotten ;  he  said  :  "  I  had  hoped  to  escape  the  acci- 
dent of  an  ether  death,  but  it  occurs  once  in  a  certain  number  of  thou- 
sands of  cases  in  the  best  hands,  and  I've  no  doubt  I  passed  my  limit 
long  ago.  We  were  not  to  blame."  Then  after  he  got  in  his  carriage 
he  leaned  out  to  say:  "  If  you  are  asked  about  this  just  say  it  was  my 
case.     I'll  accept  all  the  responsibility." 

Philosophical  and  unchanged  in  the  presence  of  calamity,  tender 
and  thoughtful  of  the  interests  of  others,  he  was  then,  as  always,  one 
man  in  ten  thousand. 

Dr.  Agnew  was  imperturbable  not  merely  as  an  operator,  but  in  all 


1 6  Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D. 

the  ordinary  relations  of  life.  No  surgeon  ever  lived  and  attained  emi- 
nence who  was  more  careful  to  throw  around  his  patients  every  safe- 
guard, or  who  strove  more  earnestly  after  successful  results  ;  and  yet 
no  surgeon  accepted  untoward  results  with  greater  equanimity  when  it 
became  apparent  that  they  were  inevitable,  or  when  the  case  had  ended. 
His  mental  attitude  under  these  circumstances  seemed  to  be  that  of  a  con- 
sistent fatalist,  and  I  have  many  times  envied  him  the  unruffled  placidity 
with  which  he  finally  learned  of  the  unfavorable  termination  which 
he  had,  perhaps,  contested  hour  by  hour  for  long  and  anxious  days. 
He  used  to  explain  it  by  saying  that  he  felt  that  he  had  done  his 
best  and  could  do  no  more,  but  he  probably  had  the  consolation  denied 
to  most  of  us  of  knowing  that  his  best  was  the  best,  although  he  was 
too  modest  so  to  express  it. 

His  patience  as  an  operator  was  equally  remarkable.  I  do  not 
remember,  as  his  assistant,  or  indeed  in  any  other  capacity,  ever  to 
have  received  a  harsh  or  unkind  word  from  him  for  faults  of  either 
omission  or  commission,  although  I  must  often  have  deserved  it.  The 
one  thing  that  used  to  elicit  from  him  an  expression  of  impatience  was 
the  breaking  of  an  important  stitch  during  a  staphylorrhaphy  or  an 
operation  for  vesico- vaginal  fistula.  He  would  then  come  as  near  to 
swearing  as  his  principles  permitted.  One  of  the  first  private  operations 
I  ever  saw  him  perform  was  for  the  relief  of  such  a  fistula  in  the  wife  of 
a  clergyman.  The  most  troublesome  stitch  broke  while  he  was  tighten- 
ing it,  eliciting  an  ejaculation  which  led  Dr.  Elwood  Wilson,  who  was 
present,  to  say,  "Agnew,  I'll  tell  Beadle  on  you  !"  referring  to  the 
Reverend  Dr.  Beadle,  one  of  the  most  admirable  and  lovable  of  char- 
acters and  then,  probably.  Dr.  Agnew' s  dearest  friend.  This  raised  a 
laugh  in  which  Dr.  Agnew  joined,  and  the  stitch  was  reinserted.  The 
incident  represents  the  full  extent  to  which  he  ever  permitted  himself 
to  show  temper,  and  I  must  confess  that  it  was  a  source  of  gratification 
to  me  whenever  a  similar  occurrence  took  place,  as  it  momentarily 
diminished  my  sense  of  inferiority. 

(4)  His  collected  writings  embrace  a  number  of  miscellaneous  arti- 
cles— important  contributions  to  the  surgery  of  lacerated  perineum  and 
vesico-vaginal  fistula  ;  papers  on  general  surgical  diagnosis,  etc. — but 
the  work  of  his  life  as  a  writer  is  his  great  "  Treatise  on  the  Principles 
and  Practice  of  Surgery,"  the  three  successive  volumes  of  which  bear 
the  dates  1878,  1881,  1883. 

It  is  safe  to  say  that  this  magnificent  monument  to  the  learning, 
skill  and  industry  of  one  man  will  remain  unrivaled  in  surgical  litera- 
ture. It  is  not  likely  that  there  will  ever  again  be  any  one  who  will 
combine  the  enormous  experience,  embracing  every  department  of 
surgery,  the  clear  judicial  intellect,  and  the  patient,  untiring  energy 


Memoir  of  D.  Hayes  Agnew^  M.D.^  LL.D.  17 

'whicli  enabled  him  in  hours  stolen  from  his  family,  from  social  pleas- 
ures and  from  much-needed  rest,  to  produce  this  remarkable  exposition 
of  his  work  and  views. 

It  was,  as  has  been  said,  his  child,  the  dearly- beloved  offspring  of 
his  brain,  and  while  I  regret  that  in  the  swift  march  of  surgical  science 
it  must,  if  left  without  revision,  inevitably  fall  into  disuse,  I  can  under- 
stand the  sentiment  which  desires  to  keep  it  unaltered  and  unchanged 
as  the  most  eloquent  of  all  records  of  his  splendid  achievements. 

And  yet  there  are  portions,  and  large  portions,  of  the  book  which 
it  seems  to  me  can  never  grow  surgically  old  or  useless.  Our  succes- 
sors may  be  too  hurried  to  read  the  abstracts  of  the  history  of  important 
surgical  procedures,  which,  with  infinite  labor  and  painstaking  he  had 
■conscientiously  compiled  ;  his  pathology  may  become  antiquated,  and 
his  therapeutic  measures  come  to  be  looked  upon  as  are  those  of  Pare  or 
Wiseman,  but  his  admirable  clinical  descriptions,  his  comprehensive  and 
well-balanced  consideration  of  diagnostic  points,  his  clear  explanation 
of  the  surgical  anatomy  of  disease,  injury  and  operation,  must  always 
remain  as  at  present,  a  mine  of  information  for  the  busy  practitioner. 

After  many  years  of  what  may  be  called  intimate  acquaintance 
with  the  book  I  venture  to  assert,  and  I  doubt  not  many  of  you  will 
■corroborate  me,  that  in  the  directions  I  have  indicated  one  may  turn  to 
it  for  help  and  guidance  with  more  certainty  of  finding  what  he  seeks 
than  to  any  other  single  treatise  on  surgery  in  his  library.  This  state- 
ment was  made  in  some  of  the  early  reviews  of  the  work,  and  I  was 
-once  present  when  a  surgeon  of  distinction  from  a  neighboring  city 
expressed  the  same  opinion  to  Dr.  Agnew.  I  remember  well  the  simple, 
unaffected  pleasure  which  it  evidently  gave  him,  and  he  afterward  told 
me  that  he  hoped  it  was  true,  as  he  regarded  it  as  a  higher 
compliment  than  any  other  that  could  be  paid  to  a  medical  work. 

The  book  went  to  a  second  edition  in  1889,  ^^^  is  well  deserving 
-of  many  future  editions.  It  is  the  property  of  the  trustees  of  the  Uni- 
versity of  Pennsylvania. 

He  was  not  a  conspicuously  original  surgeon.  He  invented  a 
number  of  instruments  and  splints,  notably  that  for  use  in  transverse 
fracture  of  the  patella;  introduced  some  new  operations,  such  as  that 
for  webbed  fingers;  modified  others,  as  the  musculo-cutaneous  flap 
method  in  amputation,  and  lateral  lithotomy  in  children,  and  made  many 
minor  improvements  in  both  surgical  apparatus  and  operative  technique. 
His  claim  to  imperishable  fame  does  not,  however,  rest  upon  any  of  his 
inventions,  nor  upon  any  one  great  addition  to  surgical  science.  It  is 
not  given  to  every  one  to  be  a  discoverer.  Dr.  Agnew  had  not  a  mind 
of  the  inventive,  speculative,  restless  type  which  contributes  the  newest 
l3ut  not  always  the  most  useful  ideas  to  our  profession.     Neither  did 


1 8  ]\Iemoir  of  D.  Hayes  Agneza,  M.D.,  LL.D. 

his  training  uor  his  circumstances  fit  him  for  the  plodding  laboratory 
work,  experimental  and  microscopic,  as  a  result  of  which  a  Pasteur  or 
a  Lister  or  a  Koch  electrifies  the  world  with  some  grand  contribution  to 
its  knowledge.  Dr.  Agnew  had  a  judicial  mind,  wonderfully  fitted  to 
weigh  and  decide  upon  the  suggestions  that  came  to  it,  and  he  had 
extraordinary  mechanical  and  physical  ability  to  carry  into  effect  in  an 
operative  way  whatever  appealed  to  his  deliberate  judgment.  As  was 
said  of  Abraham  Colles,  "  He  possessed  the  art  of  touching  briefly  on 
the  salient  point  of  his  cases,  and  was  gifted  with  what  Dove  called 
'  the  incomprehensible  talent '  of  separating  the  essential  from  the  imma- 
terialin  complicated  phenomena." 

He  was  eminently  and  above  all  others  of  his  time — I  am  almost 
tempted  to  say  of  all  times — a  sound  surgeon,  a  safe  surgeon.  One 
might  be  sure  invariablj^  that  his  opinion  in  a  given  case,  even  if  it 
were  not  finally  proven  to  be  the  right  one,  was  well  founded,  and  would 
stand  creditably  the  test  of  adverse  criticism;  and  in  every  case  and 
under  all  circumstances  it  was  equally  certain  that  the  opinion  was  given 
with  the  single  idea  of  being  of  use  to  the  phj'sician  or  patient  who  had 
consulted  him. 

In  special  departments  of  surgery  he  has  probably  been  excelled 
by  not  a  few,  but  taking  the  whole  round,  including  not  only  general 
and  operative  surgery  but  gynecology,  ophthalmology,  genito  urinary 
surgery,  syphilography,  orthopedics,  etc.,  he  attained  a  degree  of  emi- 
nence which  has  rarely,  if  ever,  been  equaled,  and  to  which  our  own 
times  and  generation  furnish  no  parallel. 

I  have  never  seen  or  known  of  an  instance  in  which  he  seemed  in 
the  least  degree  influenced  by  the  temptations  which  constantly  beset 
those  of  us  who  as  teachers  need  clinical  material,  as  operators  desire 
to  attempt  new  or  hitherto  untried  procedures,  as  practitioners  feel  the 
universal  need  of  money  and  of  prestige.  Since  the  death  of  Dr.  Charles 
Hunter,  his  previous  assistant,  which  was  a  great  loss  to  the  profession, 
to  the  University  and  to  Dr.  Agnew  himself,  I  was  intimately  associated 
with  him  in  both  his  public  and  private  work,  and  for  the  last  few  years 
he  did  me  the  honor  of  referring  to  me  those  patients  who  required 
operation.  I  may,  therefore,  claim  to  have  had  every  possible  oppor- 
tunity of  observing  and  criticizing  the  standard  of  his  conduct  in  this 
respect,  and  I  cannot  conceive  of  a  loftier  or  more  unswerving  devotion 
to  the  highest  and  best  principles  than  that  which  he  always  displayed. 
Certainly  no  one  ever  brought  to  any  occupation  a  more  profound  sense 
of  its  grandeur  and  nobility,  a  higher  estimate  of  its  relations  to  man- 
kind, or  a  more  steadfast  purpose  to  consecrate  his  whole  life  to  it  than 
did  Dr.  Agnew  to  the  study  and  practice  of  surgery. 

For  a   long  time   he  had   a  medical  practice  which  was  among 


Memoir  of  D.  Hayes  Agnezv,  M.D.,  LL.D.  19 

the  largest  in  Philadelphia.  He  retained  ii  at  first  because  he 
believed  that  while  it  was  possible  to  be  a  good  ph}'sician  with  no  sur- 
gical experience  whatever,  he  did  not  think  that  the  converse  was  true, 
but  always  held  that  a  surgeon  was  better  and  stronger  in  his  own 
department  if  he  had  had  to  watch  and  study  and  care  for  the  medical 
conditions  which  are  liable  at  any  time  before,  or  after  operation,  to 
complicate  his  purely  surgical  cases.  I^ater,  he  had  not  the  unusual 
experience  of  finding  it  next  to  impossible  to  refuse  to  see  such 
cases  in  families  who  had  for  years  been  accustomed  to  depend  upon 
him. 

His  therapeutics,,  both  in  medicine  and  surgery,  were  very  simple, 
and  I  have  found,  and  still  find,  among  the  prescriptions  brought  to 
me  by  his  patients,  astonishingly  little  variety.'  Bransby  Cooper 
remarks  of  his  distinguished  uncle:  "  So  simple  were  Mr.  Cooper's  pre- 
scriptions that  he  had  five  or  six  formulae  which,  under  ordinary  cir- 
cumstances, constituted  his  complete  pharmacopia,  and  such  medicines 
he  kept  constantly  made  up,  for  the  benefit  of  the  poor." 

Sir  Joseph  Lister  once  told  me  that  during  his  very  earliest  days  in 
Kdinburgh,  when  he  was  still  uncertain  whether  to  remain  there  or  to 
begin  his  work  elsewhere,  he  consulted  Mr.  Syme.  The  latter  told  him 
that  he  would  probably  do  well  to  stay  there,  but  remarked  that  it  really 
seemed  as  though  there  were  not  much  left  to  do  in  the  way  of  advanc- 
ing surgical  science,  little  thinking  at  the  time  that  the  young  man  he 
was  talking  to,  his  future  son-in-law,  would  almost  alone  and  unaided 
effect  the  greatest  revolution  in  surgery,  and  bring  about  the  greatest 
step  in  advance  which  has  been  made  since  Harvey  discovered  the 
circulation  of  the  blood. 

Dr.  Agnew  never,  to  my  knowledge,  wavered  in  his  profound  and 
unvarying  faith  in  the  future  of  surgery.  He  would  have  had  far  more 
reason  than  Mr.  Syme  for  believing  that  the  limit  of  possible  advance 
had  been  reached,  as  he  had  seen  the  introduction  not  only  of  anesthesia, 
but  of  antisepsis.  It  was  contrary,  however,  to  his  buoyant  and  hopeful 
disposition,  and  inconsistent  with  his  own  progressive  spirit,  to  take 
this  view  of  the  science  which  had  shown  such  infinite  capacity  for 
development.  He  believed,  for  example,  that  just  as  surgical  tubercu- 
losis is  slowly  but  surely  coming  under  the  control  of  the  surgeon,  so 
carcinoma,  the  present  opprobrium  of  surgery,  would  in  time  yield  to 
methods  of  treatment  yet  to  be  discovered.  He  was  always  among  the 
first  to  test  new  surgical  procedures  and^to  adopt  them  if  they  seemed 
to  him  consistent  with  fundamental  principles  and  common  sense. 
At  a  time  when  many  of  his  juniors  were  skeptical  as  to  the  merits 
of  antisepsis,  or  were  even  openly  antagonistic,  he  gave  it  a  thorough 
trial  and  at  once  discarded  in  its  favor  the  methods  which  he  had 


20  Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D. 

employed  for  forty  years.  He  was  among  the  first  to  advocate  the 
extension  of  the  field  of  operative  interference  in  fractures  of  the  skull, 
one  of  the  innumerable  advances  which  antisepsis  made  possible.  He 
performed  nephrectomy  and  laryngectomy,  supra-pubic  lithotomy  and 
prostatectomy-,  nerve  grafting  and  other  operations  which  were  popular- 
ized only  after  he  had  reached  an  age  when,  upon  many  minds,  a  new 
idea  has  the  effect  of  a  foreign  body  upon  the  grosser  tissues,  and  is 
either  encapsulated  and  disappears  or  sets  up  irritation  and  is  extruded. 
While  Sir  Henry  Thompson  was  impeding  the  acceptance  of  litholapaxy 
by  the  profession  in  Great  Britain,  Dr.  Agnew,  although  one  of  the 
most  accomplished  and  successful  of  lithotomists,  was  employing  it  in 
the  majority  of  his  cases  of  calculus.  He  attacked  brain  tumors,  tried 
the  modern  methods  for  the  radical  cure  of  hernia  (though  he  had  pre- 
viousl}''  devised,  employed  and  cast  aside  as  useless  a  method  of  his 
own),  removed  the  appendix  both  during  attacks  of  inflammation  and 
in  the  interval,  employed  the  most  recent  technique  in  the  treatment  of 
ununited  fracture,  and  in  every  direction  kept  full)^  abreast  of  the  times 
up  to  the  very  week  of  his  death. 

On  the  other  hand  he  could  not  be  induced  to  attempt  operations 
which  his  judgment  did  not  approve,  and  his  last  important  paper,  a 
judicial  review  of  the  results  obtained  hy  local  surgeons  in  various 
forms  of  cerebral  disease  and  injury,  was  written  partly  with  a  view  of 
establishing  the  uselessness  of  certain  procedures  which  he  believed  to 
be  unphilosophical  and  unjustifiable.  He  thought  the  evidence  showed 
that  he  was  correct,  but  if  future  experience  had  demonstrated  the  con- 
trary' to  be  true  it  is  safe  to  say  that  he  would  have  been  one  of  the  first 
to  admit  it.  I  have  alread}^  alluded  to  his  behavior  in  reference  to  his 
•own  operation  for  the  cure  of  hernia.  A  sLill  more  striking  illustration, 
however,  of  his  fair-mindedness  is  to  be  found  in  his  attitude  toward  a 
question  of  public  policy  which,  on  account  of  the  apparent  conflict 
between  hygiene  and  morals  involved  has  always  excited  the  bitterest 
contention.  I  allude  to  the  so  called  "  Contagious  Diseases  Acts,"  the 
recognition  and  regulation  of  prostitution  by  the  State.  Everything  in 
Dr.  Agnew's  religious  training  and  association,  and  many  elements  of 
his  personal  character,  tended  to  lead  him  into  the  ranks  of  the  opposi- 
tion, where  are  to  be  found  in  every  country  where  the  subject  has  been 
discussed  the  large  majority  of  the  clergy  and  a  small  minority  of  our 
profession.  In  1882,  however,  when  he  was  64  years  of  age,  he  wrote  : 
"At  one  time  I  was  disposed  to  take  sides  with  the  opponents  of  pros- 
titution laws  ;  but  on  a  more  comprehensive  and  careful  study  of  the 
subject,  and  especially  of  the  results  which  have  been  reached  in  those 
countries  where  such  legal  regulations  are  in  operation,  I  am  forced  to 
believe  that  the  evil  is  one  which  comes  legitimately  within  the  province 
of  civil  law." 


Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D.  2V 

To  my  mind  this  statement  is  one  of  the  most  interesting  examples- 
of  the  many  which  might  be  adduced  in  evidence  of  Dr.  Agnew's 
broad-mindedness  and  absolute  independence  of  thought  and  judg- 
ment. 

It  is  obvious  that  Dr.  Agnew's  physical  endurance  must  have- 
been  extraordinar}"  to  enable  him  to  carry  on  at  one  time  the  teaching,, 
writing,  operating  and  consulting,  any  one  of  which  would  have  been 
a  heavy  burden  for  an  average  man.  He  told  me  not  more  than  five- 
years  ago  that  he  did  not  know  what  it  was  to  be  tired.  One  of  the 
best  illustrations  of  both  his  strength  and  his  devotion  to  duty  is- 
afforded  by  an  experience  which  he  has  more  than  once  mentioned  to- 
me. He  was  called  by  telegram  early  one  morning  to  an  out-  of- the- way 
place  in  the  northern  part  of  the  State.  He  ate  a  hurried  breakfast, 
caught  his  train,  and  by  dint  of  close  railway  connections  and  a  final 
drive  of  eight  miles  over  a  rough  road  reached  the  house  of  his  patient 
late  in  the  afternoon.  An  operation  was  required,  and  he  performed  it 
at  once,  a  meal  being  prepared  for  him  in  the  meanwhile.  On  looking 
at  his  watch  and  consulting  a  time- table  he  found,  however,  that  hy 
starting  immediately  he  could  make  a  connection  at  Harrisburg  which 
would  enable  him  to  reach  Philadelphia  in  time  for  his  office  hours  and 
his  lecture  the  next  morning.  He  accordingly  left  at  once  and,  as  he 
told  me,  reached  home  in  time  for  breakfast  the  next  day,  without 
having  had  anything  whatever  for  twenty-four  hours  except  a  drink  of 
ice  water  on  the  cars. 

Until  a  few  years  before  his  death  he  usually  went  up  stairs  at  the 
hospital  at  a  gait  which  tried  the  legs  and  the  wind  of  the  assistants. 
When  operating  in  private  houses  heavy  persons  often  had  to  be  lifted 
from  the  bed  to  operating  table  and  back  again.  Dr.  Agnew  used  to  say 
laughingly  that  there  was  no  one  we  could  not  manage  between  us,  and  he 
continued  to  do  his  share,  and  more  than  his  share,  of  such  work  until 
I  positively  refused  to  permit  it.  Physical  labor  never  unsteadied  his 
hand  or  affected  his  operating  in  the  slightest  degree,  and  he  was  dis- 
posed to  speak  rather  disparagingly,  so  far  as  his  kindly  nature  per- 
mitted, of  those  who  were  thus  affected.  Among  other  minor  peculiar- 
ities of  fellow-surgeons  which  he  did  not  admire  was  the  disposition  to 
invent  and  employ  a  multiplicity  of  instruments.  He  made  some  addi- 
tions to  the  surgical  armamentarium,  as  I  have  already  mentioned,  but 
he  never  laid  special  stress  upon  them,  and  he  habitually  employed  the 
fewest  and  simplest  instruments  possible. 

As  an  example  of  his  extraordinary  endurance,  and  also  of  his 
physical  courage,  I  may  mention  the  fact  that  during  a  cholera  epidemic 
in  Philadelphia  he  has.  on  a  broiling  summer  night  gone  over  to  the  pit 
in  which  the  unclaimed  bodies  were  placed,  and  has  himself  injected  as- 


22 


Mevioir  of  D.  Hayes  Agneiv,  M.D.,  LL.D. 


many  as  fifteen  at  one  time,  an  amount  of  labor  and  a  degree  of  risk  to 
which  few  men  would  be  willing  to  subject  themselves.  His  expe- 
riences in  procuring  dissecting  material  were  many  and  peculiar.  He 
did  not  hesitate  in  the  case  of  unknown  vagrants  or  paupers,  where 
no  feelings  could  be  lacerated  or  shock  inflicted  upon  surviving 
relatives,  to  step  slightly  beyond  the  strict  letter  of  the  law  in  the 
interests  of  science,  and  even  has  gone  out  to  the  Potter's  Field  at 
midnight,  resurrected  a  body,  placed  it  in  a  sack  in  the  seat  of  his 
buggy  alongside  of  him,  and  driven  it  in  to  his  Chant  Street  dis- 
secting room. 

He  had  a  keen  sense  of  humor,  which  never  failed  to  respond  to  a 
good  story  or  a  jocular  remark,  and  was  always  thoroughly  appreciative 
of  innocent  fun  of  any  sort.  He  could  on  occasion  be  very  amusing, 
a  quaint  vein  of  harmless  sarcasm  running  through  his  accounts  of  his 
numerous  experiences.  I  have  heard  him  more  than  once  tell  of  an 
incident  that  occurred  while  he  was  living  at  1611  Chestnut  Street.  A 
man,  residing  in  Williamsport,  had  half  swallowed  his  artificial  denture, 
which  became  impacted  in  the  esophagus.  He  was  sent  down  to  Dr. 
Agnew,  who  met  him  at  the  Colonnade  Hotel  and  extracted  the  plate. 
An  enterprising  reporter  who  heard  of  it  rang  Dr.  Agnew's  bell  at  one 
o'clock  the  following  morning.  Mrs.  Agnew,  who  often  interposed 
between  her  husband  and  unnecessar}^  demands  upon  his  time  and 
strength,  spoke  to  the  visitor  from  the  window.  He  said  that  he  had 
learned  that  there  was  a  man  in  town  with  a  set  of  teeth  in  his  throat, 
and  he  wanted  to  get  the  particulars.  She  reported  this  to  Dr.  Agnew, 
and  asked  what  she  should  say.  He  said:  "  Tell  him  that  if  he  doesn't 
go  away  from  here  promptly  there  will  be  another  man  in  town  in  a  few 
minutes  with  a  set  of  teeth  in  his  throat." 

In  his  persistent  cheerfulness  he  resembled  most  of  the  great  sur- 
geons of  whose  histories  we  have  any  accurate  record.  Larrey  enlivened 
even  the  retreat  from  Moscow  with  his  pleasantries;  Astley  Cooper  was 
the  life  of  his  medical  club ;  Abernethy  was  famous  for  his  dry  witti- 
cisms, and  many  other  lesser  lights  were  notably  humorous. 

Much  of  his  success  was  undoubtedly  due  to  his  sympathetic  tem- 
perament, his  native  eloquence  when  discussing  any  subject  on  which 
he  felt  deeply,  and  his  remarkable  self  denial  in  the  pursuit  of  that 
science  to  which  his  life  had  been  so  thoroughly  and  completely  devoted. 
There  are  not  many  instances,  apart  from  those  of  religious  fanaticism, 
of  such  utter  abandonment  of  ordinary  aims  and  ambitions,  and  of  such 
intense  concentration  of  all  mental  and  physical  energies  upon  one  idea, 
as  characterized  Dr.  Agnew  during  the  years  when  the  struggle  was 
hardest  and  the  reward  seemed  doubtful  or  distant.  While  slow  to  go 
beyond  his  self-appointed  sphere  of  thought  and  action,  he  was  prompt 


Memoir  of  D.  Hayes  Agncw,  M.D.,  LL.D.  23 

to  resent  interference  from  those  whose  knowledge  and  research  he 
knew  to  be  superficial  and  limited  ;  and  any  suspicion  of  imposition  or 
falsehood  was  sufficient  to  excite  in  him  the  most  profound  contempt. 
Thoroughly  honest  in  all  his  convictions,  making  no  effort  to  appear 
what  he  was  not,  and  never  influenced  by  any  but  the  most  upright  and 
conscientious  motives,  he  despised  all  hypocrisy  in  others,  and  above  all 
in  those  who  prostituted  our  profession  to  what  he  considered  their  own 
personal  aggrandizement.  He  was  not,  however,  quixotic  in  his  ideas, 
and  his  native  shrewdness  and  common  sense  enabled  him  to  appreciate 
fully  the  merits  of  those  men  who,  like  himself,  gained  both  profes- 
sional and  pecuniary  success,  and  combined  properly  and  deservedly 
scientific  with  material  progress. 

He  never  asked  and  rarel}^  obtained  in  individual  cases  the  fees  to 
which  his  rank  in  the  profession  entitled  him,  although  the  aggregate 
of  his  earnings,  on  account  of  his  enormous  capacity  for  work,  was  very 
large.  His  small  charges  arose  partly  from  the  habit  formed  during 
his  earlier  days  of  practice,  partly  from  a  dislike  for  the  drudgery  of 
bookkeeping  which  resulted,  as  in  the  case  of  the  late  Dr.  Meigs,  in 
many  visits  being  unrecorded  and  forgotten,  but  chiefly  from  his  con- 
scientious desire  that  no  sick  or  ailing  person  who  wanted  or  needed 
his  opinion  should  be  prevented  by  lack  of  means  from  consulting  him. 
During  the  later  years  of  his  life  it  became  absolutely  necessary  to  limit 
his  practice  by  raising  his  fees  somewhat,  but  he  was  always  too  modest 
and  had  too  little  of  the  money-making  instinct  to  place  a  proper  valua- 
tion upon  his  services.  I  am  tempted  again  to  call  attention  to  the  par- 
allelism between  his  habits  in  this  respect  and  those  of  Sir  Astley 
Cooper.  The  language  employed  by  the  biographer  of  the  latter  might 
be  applied  without  the  change  of  a  word  to  Dr.  Agnew  :  "  There  were 
two  or  three  classes  of  persons  from  whom,  if  he  knew  their  occupation, 
he  always,  throughout  life,  made  it  a  rule  not  to  take  a  fee,  even  when 
offered  to  him.  When  this  desire  not  to  receive  any  remuneration  for 
his  advice  arose  out  of  a  belief  that  the  pecuniary  resources  of  his  patient 
were  very  limited,  he  had  the  most  happy  manner  of  expressing  it  to 
the  patient,  without  wounding  his  pride,  or  otherwise  offending  his 
feelings." 

Both  by  character  and  training  Dr.  Agnew  was  law-abiding  and 
scrupulously,  even  rigidly,  correct  in  all  the  details  of  his  life,  but  on 
the  other  hand,  for  those  who,  less  fortunate  in  temperament  or  educa- 
tion or  surroundings,  succumbed  to  temptations  which  to  him  were  so 
ineffective  as  to  be  practically  non-existent,  his  sympathy  and  compas- 
sion were  never- failing.  No  one  was  farther  than  he  from  the  Puri- 
tanical morality  which,  negatively  virtuous  and  technically  Christian, 
-finds  the  chief  solace  for  its  own  discomforts  in  the  contemplation  of 


24  Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D. 

the  failings  of  others,  and  its  greatest  pleasure  in  sour  and  sarcastic  con- 
demnation of  their  errors. 

Not  that  he  could  not  be  tenacious  to  the  last  degree  of  his  own 
opinions  when  he  considered  that  a  principle  was  involved.  He  never 
varied  in  his  belief  that  the  theatres,  against  which  he  once  wrote  a 
vigorous  philippic,  were  on  the  whole  both  a  cause  and  a  symptom  of 
moral  deterioration  in  the  community,  an  index  of  retrogressive  civiliza- 
tion. He  never  approved  of  the  co-education  of  the  sexes,  nor  of  the 
medical  education  of  women  under  any  circumstances,  believing  that 
any  possible  advantages  to  them  were  far  more  than  counterbalanced 
by  what  he  thought  would  be  the  inevitable  loss  of  dignity  and  deli- 
cacy resulting  from  the  association  of  the  sexes  under  such  conditions 
and  from  the  character  of  their  studies.  In  accord  with  the  one  opinion 
he  denied  himself  during  his  whole  life  the  pleasure  which  he  would 
undoubtedly  have  derived  from  seeing  the  masterpieces  of  the  drama, 
many  of  which  he  was  fond  of  quoting,  enacted  on  the  stage.  In  accord 
with  the  other,  he  resigned  a  valuable  hospital  position,  and,  in  spite 
of  strong  pressure,  refused  many  lucrative  consultations. 

He  was  never  an  advocate  of  what  is  now  called  the  higher  educa- 
tion of  women  in  any  direction.  He  admired  the  domestic  virtues, 
and  at  one  of  the  last  dinners  he  ever  gave,  remarked  that  a  woman 
should  be  taught  housekeeping,  hygiene  and  belles-lettres.  After  that, 
he  said,  the  more  she  knew  the  worse  off  she  was. 

He  valued  highly  the  opinions  of  those  whom  he  considered  his- 
peers  in  the  surgical  world,  but,  as  a  rule,  entirely  disregarded  all 
criticism  of  himself,  or  of  his  doings,  whether  favorable  or  the  reverse. 

In  1882,  after  the  conclusion  of  Guiteau's  trial,  Dr.  Hays,  editor 
of  the  Medical  News,  asked  Dr.  Agnew  to  prepare  a  statement  of  the 
Garfield  case,  which  should  serve  as  an  answer  to  the  unfavorable 
criticism  of  its  conduct  made  by  Dr.  William  Hammond  and  a  few 
notoriety  seekers  among  the  laity.  Dr.  Agnew  at  first  consented,  but 
on  reflection  decided  that  it  would  not  be  dignified  or  proper  for  him 
personally  to  notice  such  attacks,  and  asked  me  to  write  the  paper 
and  state  that  it  met  with  his  approval.  This  I  did,  and  this  was  the 
only  notice  he  took  of  the  bitter  public  accusations  which  involved 
him  equally  with  the  other  consultants  and  the  medical  attendants. 
A  statement  he  had  made  to  me,  which  I  had  previously  published, 
and  a  letter  he  had  written  to  Dr.  William  Hunt,  were  evidence  that  he 
knew  from  the  beginning  the  surgical  impossibility  of  locating  or 
extracting  the  missile,  and  recognized  at  the  same  time  the  probable 
hopelessness  of  the  case.  But  his  cool  judgment  and  calm  superiority 
to  popular  clamor  and  professional  pressure  prevented  those  facts  from, 
being  made  public   at  a  time  when   their  promulgation  would  have 


s 


Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D.  25 

wrought  serious  harm  to  great  national  interests.  His  high  sense  of 
honor  in  all  his  relations  as  a  consultant  was  never  better  illustrated 
than  in  the  same  case.  I  cannot  even  now  go  into  details  with 
propriety,  but  I  may  venture  to  say  that  had  he.  divorced  his  interests 
from  those  of  some  of  the  gentlemen  who  saw  the  case  earlier,  he  could 
easily  have  avoided  all  responsibility  for  those  portions  of  the  treatment 
most  open  to  hostile  criticism.  This,  however,  he  would  not  permit, 
preferring  to  stand  by  his  professional  brethren  even  under  fire,  and  in  a 
case  which  he  know  would  be  historical. 

His  refusal  to  make  a  charge  for  the  many  days  and  nights  which 
Tie  had  spent  with  the  President  during  nearly  three  months,  involving 
a  loss  of  weeks  from  his  practice,  then  probably  the  largest  and  most 
lucrative  ever  acquired  by  an  American  surgeon,  and  the  niggardly 
behavior  of  Congress  in  appropriating  a  sum  which  gave  him  only 
^5000,  a  sum  less  than  he  should  have  received,  or  could  properly  have 
charged  for  one- tenth  the  service  rendered,  are  also  matters  of  history. 

After  his  retirement  from  the  chair  of  surgery  he  gave  each  year, 
at  my  urgent  solicitation,  backed  by  that  of  the  class,  a  clinic  at  the 
University  Hospital.  It  was  always  known  in  advance,  and  the  amphi- 
theatre was  packed  from  floor  to  ceiling.  At  the  first  sight  of  his 
stately  figure  and  silvered  head  the  applause  began,  as  vociferous  and 
deafening  as  only  a  medical  class  can  make  it,  and  continued  until  by 
a  quiet  motion  of  the  hand  he  indicated  his  desire  for  silence.  He 
never  lost  his  hold  on  the  love  and  respect  of  the  students,  and  until 
the  day  of  his  death  was  the  most  popular  member  of  the  University 
Faculty.^ 

In  1888  the  beginning  of  degenerative  changes  was  manifested  by  a 
violent  attack  of  renal  colic.  He  sent  for  me  one  morning  about  four 
or  five  o'clock.  I  found  him  sitting  in  a  chair  in  his  bed-room,  leaning 
over  the  back,  bathed  in  a  cold  perspiration,  with  a  feeble  pulse  and  in 
an  agony  of  pain.  On  inquiry,  I  learned  that  this  had  been  his  condition 
for  some  hours,  and  on  asking  him  why  he  had  not  sent  for  me  sooner 
found  that  he  had  not  wanted  to  disturb  me,  as  he  knew  I  had  been  out 
late  to  see  a  patient  for  him  the  evening  before.  I  felt  ashamed  when  I 
thought  how  promptly  I  would  have  sent  for  him  if  I  had  had  a  tithe 
of  the  pain  from  which  he  was  suffering. 

His  first  serious  breakdown  was  in  1889,  when  he  was  confined  to 
his   bed   with   influenza.     I    attended   him   in   conjunction   with    Dr. 

iThe  cut  on  the  opposite  page  is  from  the  celebrated  oil  painting  by  the  distinguished 
Philadelphia  artist,  Mr.  Thomas  Eakens.  Dr.  Agnew  is  portrayed  in  his  customary  attitude  at 
the  completion  of  an  operation  (in  this  case  the  removal  of  a  carcinomatous  breast),  explaining 
its  details  while  the  hemorrhage  is  being  arrested.  The  faces  of  assistants,  students  and 
onlookers  are  portraits.  The  picture  was  painted  in  1888,  the  last  year  of  Dr.  Agnew's  active 
work  as  a  teacher. 


26  Memoir  of  D.  Hayes  Agnew,  M.D.,  LL.D. 

William  Pepper.  He  made  a  slow  convalescence,  interrupted  and  pro- 
longed by  supra-orbital  neuralgia  and  lumbar  myalgia. 

In  1890  he  fell  on  the  marble  floor  of  his  hall  and  violently  struck 
the  back  of  his  head.  I  was  never  certain  whether  this  was  from  a 
sudden  vertigo  or  not,  and  have  thought  that  it  might  account  for  the 
development  of  diabetes,  which  took  place  later  in  that  year,  when  he 
was  again  invalided  under  the  care  of  Dr.  James  Tyson  and  myself  for 
a  period  of  some  weeks;  but  the  autopsy  disclosed  no  cerebral  condition 
which  could  have  been  associated  with  traumatism. 

Soon  after  he  began  to  develop  distinct  anginose  symptoms. 

lyast  Spring,  before  entering  the  clinic  room  for  his  usual  lecture, 
he  told  me  that  he  felt  excessively  nervous,  and  after  the  lecture  he 
said  that  the  excitement  had  given  him  a  great  deal  of  precordial  pain. 
He  spoke  once  more  in  public,  at  the  University  dinner  at  Musical  Fund 
Hall,  and  had  the  same  experience.  He  said  as  we  drove  down  there 
that  he  had  determined  to  give  up  public  speaking,  and  regretted  that 
he  had  undertaken  it  on  this  occasion.  If  I  may  be  forgiven  for 
pushing  a  favorite  idea  a  little  farther,  I  should  like  to  note  that  after 
describing  Cooper's  final  address,  his  nephew  says,  ' '  This  was  the  last 
time  he  appeared  as  a  public  lecturer,  for  he  found  that  the  excitement 
of  the  scene  and  the  exertion  of  delivery  increased  his  tendency  to  the 
attacks  to  which  he  had  lately  been  liable." 

Those  who  were  present  at  the  dinner  will  remember  Dr.  Agnew' s 
description  of  the  members  of  the  faculty  under  whom  he  had  graduated 
in  1838.  His  words  were  well  chosen,  and  his  account  of  their  peculiari- 
ties was  most  interesting ;  but  it  was  only  too  evident  that  he  was  no 
longer  fit  for  even  the  slight-  strain  which  this  imposed  upon  him.  As 
I  went  down  stairs  to  see  him  into  my  carriage,  which  I  had  kept 
waiting  for  him,  he  looked  so  badly  that  I  suggested  that  I  had  better 
go  home  with  him,  but  with  a  touch  of  his  old  spirit  he  said :  "No  ;  I 
don't  need  a  chaperon;  I'm  old  enough  to  be  trusted  out  alone  at 
night." 

With  the  exception  of  a  week  or  two,  when  he  was  laid  up  with  a 
mild  recurrence  of  the  influenza,  he  was  at  work  all  the  spring,  keeping 
his  office  hours  and  attending  the  almost  daily  operations  which  I  had 
the  honor  of  performing  on  his  patients.  His  interest  in  surgery  never 
flagged,  and  not  long  before  his  death,  after  watching  for  an  hour  or 
more  a  tedious  and  difficult  dissection  of  the  neck  for  the  removal  of  a 
growth,  he  looked  at  his  watch,  saw  that  it  was  far  past  his  dinner 
hour  and  said  :   "Well,  I'd  rather  see  that  any  day  than  eat  dinner." 

He  never  thought  that  he  could  be  quite  happy  if  he  were  alto- 
gether without  occupation.  In  1879,  when  he  was  sixty-one  years  of 
age,  he  expressed  his  views  upon  the  question  of  the  retirement  of  men 


Memoir  of  D.  Hayes  Agnezv,  M.D.,  LL.D.  27 

of  advanced  years  from  active  work  when  as  chairman  of  a  dinner 
given  to  Dr.  S.  D.  Gross  on  the  completion  of  his  fifty-first  year  in  the 
profession,  he  said  :  "  It  is,  I  fear,  too  commonly  thought  in  these  days 
of  mad  haste  for  preferment,  place  or  power,  that  men  when  they  have 
passed  three-score  and  ten  years  should  gracefully  retire  to  the  shades 
of  private  and  inactive  life,  leaving  the  field  to  younger  athletes.  This 
is  a  great  mistake.  .  .  .  There  is  something  in  the  grace  and  dignity  of 
age ;  its  serene  complacency  of  mind  which,  when  coupled  with  an 
affluent  wealth  of  knowledge  and  rich  stores  of  observation  and  experi- 
ence, renders  the  presence  of  old  men  in  our  midst  pillars  of  strength 
not  only  in  a  profession  like  our  own,  but  to  the  community  at  large ; 
indeed,  to  the  world." 

On  the  8th  of  March  last  year  I  removed  a  recurrent  sarcoma  of 
the  abdominal  wall  from  a  lady,  a  patient  of  Dr.  Agnew's  and  Dr. 
Murray  Cheston's,  who  had  been  originally  operated  on  by  Dr.  Agnew 
thirteen  years  previously.  It  is  for  me  a  memorable  operation,  as  it 
proved  to  be  the  last  one  at  which  I  was  to  have  the  honor  and  the 
comfort  of  Dr.  Agnew's  presence.  The  weather  was  cold  and  stormy. 
Before  leaving  the  house  he  told  me  that  if  he  felt  no  better  the 
next  day  he  would  expect  me  to  operate  for  him  on  an  epithelioma 
of  the  lip  in  a  patient  of  Dr.  E.  W.  Watson's.  Early  the  following 
morning  I  had  a  note,  the  last  I  ever  received  from  him,  saying 
that  as  he  was  quite  well,  and  as  the  operation  was  so  trifling,  he 
would  do  it  himself.  I  ventured  to  write  him  and  advise  against  it, 
but  ineffectually.  Dr.  Watson  tells  me  that  it  was  only  with  the 
greatest  difficulty  that  Dr.  Agnew  succeeded  in  removing  the  little 
growth,  as  immediately  after  his  arrival  at  the  patient's  house  the 
anginose  pains  were  so  severe  that  he  was  unable  to  stand,  and  he 
required  full  doses  of  brandy  and  some  minutes'  rest  before  and  during 
the  operation,  which  was  the  last  he  ever  performed.  He  saw  another 
patient  later  in  the  day  in  consultation,  and  climbed  two  flights  of 
stairs  to  do  so.  This  brought  on  such  a  severe  attack  of  cardiac  pain 
that  it  was  with  difficulty  he  reached  home.  He  was  then  utterly 
prostrated,  and  lay  in  the  operating  chair  in  his  office  for  some  hours. 
During  this  time  Dr.  DaCosta,  who  came  over  at  once  from  his  office, 
saw  him,  and  tells  me  that  he  regarded  his  condition  as  extremely 
critical.  I  visited  him  an  hour  or  two  later  in  response  to  an  urgent 
note  from  Mrs.  Agnew,  which  I  found  awaiting  me  at  my  house  late 
in  the  afternoon.  He  was  then  cheerful  and  free  from  pain,  and  gave 
me  the  above  account  of  his  day.  With  the  help  of  Dr.  Edward 
Martin  and  Dr.  George  de  Schweinitz  I  carried  him  up  to  his  bed, 
which  he  never  left  again. 

I  am  sure  I  may  say  that  in  the  days  that  followed  he  was  well 


28  Memoir  of  D.  Hayes  Agnezv,  M.D.,  LL.D: 

and  tenderly  cared  for.  In  addition  to  the  loving  and  watchful  atten- 
tion which  his  devoted  wife  and  niece  bestowed  upon  him  incessantly, 
day  and  night,  he  was  almost  never  without  a  physician  in  immediate 
attendance.  Dr.  Alfred  Wood  and  Dr.  Judson  Daland  divided  the 
days  with  me  ;  I  spent  each  night  in  the  house  and  saw  him  at  short 
intervals;  and  the  consultants,  Drs.  Da  Costa  and  Pepper,  were  assidu- 
ous and  untiring  in  their  efforts  to  bring  about  his  recovery.  There 
were  dozens  of  volunteers  who  would  have  considered  it,  as  we  did,  a 
privilege  to  evince  their  love  and  respect  by  similar  services. 

During  this  last  illness  he  showed  the  same  sweet,  uncomplaining, 
well-balanced  disposition  that  had  characterized  him  all  his  life.  At 
first,  even  in  the  thick  of  the  grave  paroxysms  of  angina  pectoris  that 
gave  him  such  distress,  his  professional  judgment  remained  unimpaired, 
and  the  most  valuable  and  practical  suggestions  received  by  the  attend- 
ing physicians  and  consultants  came  from  the  patient  himself.  lyater, 
when  diabetes  re-developed  and  the  brain  began  to  become  clouded, 
he  dozed  for  most  of  the  time,  but  he  still  retained  his  old  interest  in 
everything  relating  to  surgery.  When,  after  an  absence  of  an  hour  or 
two,  I  would  return  to  his  bedside  he  would  invariably  ask  as  to  what 
had  occurred  surgically,  and  the  formula,  "  What's  new  ?  "  on  his  lips 
meant,  ' '  What  operation  have  you  been  doing  ?  what  cases  have  you 
been  seeing  ? ' '  An  operation  postponed  on  account  of  his  illness  was 
remembered  and  inquired  about  the  day  before  he  died.  At  about  the 
same  time  in  conversation  with  him  mention  was  made  of  a  mutual 
friend  who  had  recently  undergone  a  severe  operation  upon  the  face. 
Dr.  Agnew  was  quiet  for  some  minutes,  and  those  about  the  bed  spoke 
of  other  matters,  but  he  opened  his  eyes  suddenly  and  said,  "  Is  the 
scar  well  placed  ?  "  I  at  first  thought  he  was  wandering,  and  made 
some  remark  about  the  effect  of  the  morphia  he  had  taken,  but  he 
speedily  made  clear  that  he  wanted  accurate  information  as  to  an 
important  detail  in  the  surgery  of  the  case.  "  Did  you  take  that  breast 
out?"  was  the  greeting  on  another  occasion,  when  the  mind  was 
becoming  feeble  and  when  it  was  supposed  that  all  outside  interests  had 
departed,  but  the  question  referred  to  a  specific  operation  upon  a  rela- 
tive of  one  of  his  colleagues. 

The  attacks  of  angina  which  at  first  were  brought  on  by  even  a 
change  of  position  in  bed  gradually  diminished  in  frequency  and 
severity,  and  for  some  days  the  outlook  was  promising,  but  later 
diabetes  reappeared,  he  grew  dull  and  drowsy,  stupor  deepened  into 
coma  and  he  died  on  March  22,  surrounded  by  loving  friends  and  rela- 
tives. The  announcement  of  his  death  was  followed  by  manifestations 
of  grief  so  widespread  and  so  striking  as  to  make  it  assume  the  propor- 
tion of  a  public  calamity,  and  no  one  who  was  present  at  his  funeral  and 


Memoir  of  D.  Hayes  Agneiv,  M.D.,  LL.D.  29 

saw  the  stream  of  persons  of  all  ages  and  conditions  who  filed  past  his 
coffin  could  have  failed  to  be  impressed  by  the  hold  which  he  had  upon 
the  respect  and  affection  of  this  community. 

It  is  to  be  noted  that  the  cardiac  conditions  found  at  the  autopsy 
were  similar  to  those  found  in  John  Hunter  and  Sir  Astley  Cooper. 

I  have  had  the  good  fortune  to  number  among  my  acquaintances, 
and  I  think  I  may  say  my  friends,  four  whose  names  could  not  be 
omitted  from  the  roll  of  the  great  men  of  this  century.  Two  were  devo- 
tees of  pure  science,  Agassiz  and  Leidy;  two  were  surgeons,  Agnew 
and  Lister.  I  have  over  and  over  again  thought  of  the  remarkable 
similarity  in  their  personal  characteristics,  which  was  so  striking  that  a 
descript'on  of  one  applies  equally  to  all.  Simple  and  unaffected  in 
their  manners,  kind  and  courteous  in  their  treatment  of  every  one  with- 
out regard  to  social  conditions;  slow  to  take  and  even  slower  to  give 
offense;  broad  in  all  their  views  of  life  and  its  complex  relations; 
modest  to  the  point  of  diffidence  where  their  own  merits  were  concerned; 
ready  to  give  freely  and  earnestly  from  their  overflowing  stores  to  the 
humblest  seeker  after  knowledge;  earnest  and  sincere  without  being 
quarrelsome;  good  with  no  shadow  of  self-righteousness,  they  seem  to 
me  to  hold  up  to  poor  human  nature  examples  that  should  stimulate  and 
encourage  even  the  worst  or  the  weakest  among  us. 

The  words  which  my  father,  whose  pride  it  was  to  count  L,eidy  and 
Agnew  among  his  personal  friends,  used  in  an  obituary  memoir  of  the 
former  would  describe  them  all:  "  Appreciation  of  his  rare  intellectual 
gifts  was  forgotten  in  admiration  of  his  sincere,  sweet-tempered,  loving 
nature.  Retiring  and  unassuming ;  genial  and  kindly  in  spirit  and 
manner,  the  friend  of  all,  the  enemy  of  none;  as  approachable  as  a 
child,  ready  at  all  times  and  with  evident  pleasure  to  give  the  benefit 
of  his  knowledge  to  all  who  sought  it,  his  death  will  be  mourned  wher- 
ever science  is  valued  throughout  the  earth,  but  we  especially  will  miss 
his  kindly  face,  his  ready  hand,  his  cordial  greeting,  and  his  noble 
example  of  industry,  integrity  and  manly  character." 

By  the  death  of  Dr.  Agnew  our  profession  suffered  a  loss  of  the 
greatest  magnitude,  and  one  which  is  perhaps  altogether  irreparable. 
There  remain  men  equally  eminent  in  some  departments  of  surgery; 
men  of  equal  ability  as  public  expounders  of  surgical  principles;  men 
whose  earnest  and  self-sacrificing  devotion  to  medicine  in  its  broadest 
scope  cannot  for  one  moment  be  questioned ;  but  there  is  probably  not 
one  who,  combining  in  himself  all  these  qualities,  possesses  in  addi- 
tion the  skill  in  observation,  the  personal  magnetism,  the  singleness  of 
soul,  the  ceaseless,  untiring  energy  which  made  Dr.  Agnew  not  only 
one  of  the  greatest  surgeons  but  also  one  of  the  best  citizens  of  this  or 
an}^  country.     When  I  come  to  review  finally  his  record  in  the  many 


30  Memoir  of  D.  Hayes  Agnezv,  M.D.,  LL.D, 

important  relations  of  his  life,  and  remember  his  unswerving  advocacy 
of  all  that  tended  to  raise  the  standard  of  teaching  and  of  our  profes- 
sion; his  resolute  support  of  every  progressive  movement  at  the  insti- 
tutions with  which  he  was  connected;  his  unsurpassed  ability  as  a 
clinical  and  didactic  lecturer,  and  his  conscientious  discharge  of  the 
duties  of  those  positions;  his  remarkable  work  as  a  practitioner,  oper- 
ator and  consultant;  his  genuine  love  for  that  work,  and  his  eager 
desire  to  acquire  any  new  fact  that  might  benefit  his  patients;  his  respect 
for  every  honest  opinion,  even  if  it  differed  from  his  own;  his  quick 
and  ready  sympathy  and  his  tender  treatment  of  all  who  claimed  his 
help;  his  generous  support  of  the  feeble,  the  halting  and  the  unfortu- 
nate in  the  profession;  his  gentle  courtesy,  kindly  bearing  and  warm 
friendship  which  never  failed  in  time  of  need,  I  can  well  believe  not 
only  that  our  profession  has  suffered  an  irreparable  loss,  but  that 
there  are  many  who,  like  myself,  feel  that  they  have  sustained  a  per- 
sonal bereavement  which  time  may  soften  but  cannot  efface. 

It  is  a  consolation,  gentlemen,  to  know  that  he  lived  to  receive 
and  appreciate  the  highest  rewards  that  the  profession  has  it  in  its 
power  to  offer.  In  the  poem  which  our  President  read  to  him  on  the 
occasion  of  his  jubilee  in  1888,  he  recalled  the  imaginative  promise  of 
Minerva  to  the  lad  who  a  half  century  earlier  had  taken  his  degree  in 
medicine : 

"  But  I  will  take  you  where  the  great  have  gone 

And  I  will  set  your  feet  in  honor's  ways  ; 
Friends  I  will  give  and  length  of  crowded  years, 

And  crown  your  manhood  with  a  Nation's  praise." 

When  we  mourn  his  departure  from  among  us,  and  miss  his  strong 
hand  and  friendly  face  and  wise  counsel,  it  is  at  least  some  comfort  to 
know  that  the  honor  and  the  friends  and  the  praise  came  to  him  with- 
out stint,  and  that  he  died  in  the  knowledge  that  he  was  the  well- 
beloved,  the  "dear  old  man"  of  the  profession. 
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